A 30 year old man attended the emergency department with a 4 hour history chest pain that radiated into his back. There were no other symptoms. On examination he had a pulse of 110 per minute, blood pressure 142/72 mm Hg, SaO2 97% on air and temperature 37.5◦C. There were no cardiovascular or abdominal signs. There was no surgical emphysema in the supraclavicular fossae. Keywords: There were no other symptoms